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111ZI IWAVOW1 <br />IATA Z1414Z ins <br />1810 E KAMTON AVE. ST <br />DEVELOPMENT SERVIM PHONE (W91 460-3120 <br />PLANNMIG PHONE- tZ091 468-3120 <br />SURDNG PHONE tMI 468-3123 <br />NEIGHBORHOOD PREMWATION PHONE. 12091468-3021 <br />n <br />ner <Sc_� Phone No. <br />lontractor �k U <br />Z1624,- Phone No. Zej -33 <br />In' <br />License No. <br />P <br />1 <br />1 <br />INDICATE METHOD OF BACKPILL QUALITY ASSURANCE <br />1. Submission of Soil Engineer's Compaction Report within 30 days of project <br />.completion, or <br />2. Submission of verification, e.g.-"- load ticket, within 30 days of project <br />completion that one of the following materials was placed in the excavation in <br />1211 lifts® <br />Pea gravel - smooth, rounded material not more than one-half (1/2) <br />inch in diameter. <br />Z <br />Z a. Crushed rock - self -compacting material not more than three-quarters <br />(3/4) inch in cross sectional measurement. (Use of crushed rock <br />will not be permitted for backfill if contact will be made between <br />the backfill material and tanks/pipes made of. poly resin glass or <br />similar materials.) <br />DECA�` l`=OIV <br />hereby certif y that a Soil Engineer's Compaction Report will be submitted within 30 days <br />of project completion, or submission of verification that the select material described above <br />11 be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and <br />at the entire excavation will be backf Illed and compacted to insure compliance with the <br />iform Building Code Appendix Chapter 70. <br />Shall be the responsible managing employee on the license or authorized <br />agent. <br />t91-LC/BECERT.DOC <br />P <br />Name (Print) <br />Cc.VL A EC�_ <br />-- <br />Title (P <br />Signature <br />Shall be the responsible managing employee on the license or authorized <br />agent. <br />t91-LC/BECERT.DOC <br />P <br />